Rheumatic heart disease: a school-based experience in guinea bissau

Abstract Introduction Rheumatic heart disease (RHD) remains a major cardiovascular issue in developing countries. Currently, large population-based data regarding RHD in Guinea Bissau are lacking and most of the patients are diagnosed with advanced stages. Our school-based echocardiography screening aimed at determining the prevalence of RHD and its socioeconomic distribution in Guinea Bissau. Methods Children (5–15 years old) from the Bissau region were enrolled from March 2017 to April 2020 in selected primary and secondary schools. Every child underwent echocardiography and group A streptococcus swab test. Presence of RHD was defined according to the World Heart Federation criteria for individuals ≤20 years. Results A total of 6784 children were screened: 585 (8.6%) participants had a positive swab test and received single dose of benzathine-penicillin-G, with the majority, 417 (71.3%) living in rural areas. A total of 6784 out-clinic echocardiography exams were performed; 1121 (16.5%) were positive for RHD (possible or definite), of which 606 (54.1%) were from rural areas. Every child with RHD (definite or probable) was invited for an outpatient visit in a clinic in Bissau, 863 (77%) attended the visit and echocardiography was repeated. RHD was confirmed in 659 cases (58.8%). Every child with confirmed RHD started secondary prophylaxis with BPG (or oral erythromycin in case of known penicillin allergy) every 21–28 days. At a median follow-up of 3 years only 391 (59.4%) continued regular administration. Estimating a population of 798370 subjects aged 5–15 years, we calculated a national prevalence of silent RHD of 77522 subjects, almost 1 every 10 children. Conclusions A school-based echocardiographic screening has an important role in the detection of subclinical RHD. In our population the prevalence of RHD is 9.7% with a significant difference between rural and urban areas, which is an additional challenge for health care providers. Additionally, regular administration of secondary prophylaxis is jeopardised by high attrition rate and lost-to-follow-ups. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Public fundraising on social media and at local events